Asian Pacific Journal of Health Sciences

Perception of Matched Sibling Hematopoietic Stem Cell Donor about Donation of Stem Cells

Sun, 20 Oct 2024 00:00:00 +0000

Allogeneic hematopoietic stem cell transplantation (HSCT) is the curative treatment option for a variety of hematological disorders. Usually, stem cells for HSCT are obtained from matched related donors through bone marrow harvest or apheresis. Although stem cell donation is relatively a safe procedure, there are many psychosocial concerns among potential donors regarding the donation of stem cells and its possible complications. The present study aims to understand the experience of being a hematopoietic stem cell donor for a sick sibling. Eighty hematopoietic stem cell sibling donors were interviewed with a self-structured questionnaire comprising of 3 domains-intrinsic and extrinsic motivators and deterrents. Data were analyzed using descriptive and inferential statistics using IBM SPSS® Statistics version 20.0. The present study found that nearly half of them (47.5%) were <30 years of age with 52.5% being male, 57.5% were married and 53.8% were employed. 43.8% were graduates of which 7.5% had a family income of <Rs.5,000. 51.2% hailed from rural backgrounds. The majority of them (90%) of them had no co-morbidities. All of them underwent local anesthesia and had peripheral stem cells as the source of harvest. None of them had a previous history of stem cell donation. The majority of the matched sibling donors were primarily influenced by intrinsic factors (median score-3.2). The influence of the deterrents is lesser than the influence of the motivators (median score-1). There is a statistically significant association between gender and the influence of extrinsic motivators (P = 0.024), marital status and deterrents (P = 0.003), and age and deterrents (P = 0.019) in the hematopoietic stem cell donation process. Among the deterring facets, the emotional concern of being responsible for the outcome of the transplant was the major barrier (45%). The family concern of taking up the burden of being a donor and a family member is the least deterring facet (62.5%). Among the intrinsic motivating facets, positive feelings (87.5%) and family loyalty (81.3%) were the major motivating factors whereas reinvesting back into the community was the least intrinsically motivating factor (32.5%). Among the extrinsic motivating facets, complete awareness of the donation process through explanation was the highly motivating factor (93.8%). Family pressure/social obligation was the least extrinsically motivating facet (83.8%). The study highlights the role of intrinsic motivation in the stem cell donation process and warrants for further exploration.

Holistic Approaches: Ayurveda and Conventional Medicine in Diabetic Foot Ulcer Care: A Case Series

P. Sreenadh, T. S. Dudhamal — Tue, 05 Nov 2024 00:00:00 +0000

Diabetic foot ulcers (DFUs) are a significant complication of diabetes, often leading to non-healing wounds that are prone to infection and may result in amputation or death. Given the complex pathogenesis, an integrative approach combining Ayurveda and conventional medicine can be more effective. This report presents three cases of DFUs on the sole. Following adequate wound debridement, the ulcers were managed using the principles of Vrana Chikitsa from Ayurveda, along with infection control and offloading according to conventional treatment principles. Regular wound care and assessments were done. The wounds gradually became healthy, with a reduction in slough and smooth healing observed in all cases. Complete wound contraction was achieved in <1 and a 1/2 months, with no recurrence observed during a 1-year follow-up. This holistic approach can facilitate faster healing in chronic, non-healing DFUs.

Evaluating Endocrine Changes and Surgical Complications following Endoscopic Transsphenoidal Excision of Pituitary Macroadenomas

Subodh Gautam, Saharoj Siddiqui, Santosh Yadav, Purnika Dhungana — Thu, 14 Nov 2024 00:00:00 +0000

Background: Intracranial lesions arising in the region of the pituitary gland are relatively common. Pituitary adenomas (PAs) with extensive suprasellar extension are a challenge for therapeutics. For evaluation of PAs, the clinical and biochemical assessment stands as the cornerstone. The easy access of advanced neuroimaging has increased the sensitivity of detection of smaller lesions in the pituitary region. Many treatment modalities have developed so far undergoing numerous refinements over the past 100 years. Transsphenoidal surgery is considered relatively safe and widely being practiced. Materials and Methods: This was a hospital-based cross-sectional study conducted in national neurosurgical referral center, Bir hospital, Kathmandu, Nepal, on 38 patients who underwent endoscopic endonasal transsphenoidal pituitary gland excision for pituitary macroadenomas. Results: The mean serum prolactin (PRL) level was observed as 706.57 ± 1196.09 ng/mL preoperatively and 42.91 ± 109.1 ng/mL postoperatively. The mean value of growth hormone (GH) was observed as 13.34 ± 12.59 ng/mL preoperatively which was reduced to 6.48 ± 6.90 ng/mL postoperatively. Postoperatively, neurogenic diabetes insipidus was observed in 12 patients. 5 patients had cerebrospinal fluid (CSF) leak postoperatively. Meningitis was seen in 2 cases. Conclusion: Endoscopic endonasal transsphenoidal pituitary gland excision is an effective surgical modality for the management of pituitary macroadenomas which led to significant improvements in endocrine function postoperatively. The marked decrease in serum PRL and GH levels postoperatively shows the efficacy of this surgery in treating hormone-secreting adenomas. Complications such as neurogenic diabetes insipidus, CSF leaks, and meningitis should be an important consideration in the post-operative care even though they are less frequent.

Formulation and Evaluation of Gastroretentive Floating Microspheres of Amiloride Hydrochloride

Suraj Kumar , Bishnu Upreti — Thu, 14 Nov 2024 00:00:00 +0000

Background: Amiloride, a potassium-sparing diuretic, is widely prescribed for the management of hypertension, congestive heart failure, and various renal disorders. However, its low oral bioavailability due to extensive first-pass metabolism and short half-life necessitates frequent dosing, leading to patient inconvenience and compromised therapeutic outcomes. To address these limitations, the development of novel drug delivery systems capable of enhanced gastrointestinal retention of amiloride has garnered significant attention. Among these, gastroretentive microspheres represent a promising approach, offering prolonged drug release and improved absorption. Objectives: The present work by formulation and evaluation of gastroretentive floating microsphere (FM) plays a highly significant role as a particulate drug delivery method. Particle sizes for microspheres range from 0.1 to 200 μm, and they can be administered orally, parenterally, nasally, ophthalmologically, transdermal, colonically, etc. Site-specific targeting and enhanced release kinetics are just two of the issues that have been solved through recent advances in microspheres, including those that are mucoadhesive, hollow, floating, micro-balloons, and magnetic. Microspheres will play a key role in novel drug delivery in the future by fusing different new methods, particularly sick cell sorting, genetic materials, safe, targeted, and effective drug delivery. Discussion: Hydroxypropyl methylcellulose (HPMC), polyvinylpyrrolidone, and ethylcellulose were used in varying concentrations to give the FMs of amiloride HCl release-controlling properties by increasing their bioavailability. Lactose was used as a diluent and sodium bicarbonate served as an effervescent agent. Using a solvent evaporation method approach, the gastroretentive FM of amiloride HCl was created. The generated microsphere indicated good floating strength and remained buoyant in the sustained released medium for 24 h. For systemic delivery of amiloride, a potassium-sparing diuretic and antihypertensive medication, through the oral route, a gastroretentive FMs drug delivery system was developed. The different ratios of ethylcellulose and HPMC K-100, sodium lauryl sulfate, sodium bicarbonate, and ethanol are used in formulation. The weight, thickness, percentage of moisture absorbed and lost, surface pH, folding resistance, content homogeneity, in vitro residence time, in vitro release, and ex vivo penetration of the microspheres were all assessed. Conclusion: The formulation and evaluation of gastroretentive FMs represent a significant advancement in particulate drug delivery systems. These microspheres, with particle sizes ranging from 0.1 to 200 μm, offer versatility in administration.